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i <br />l <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereitwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS S(3AI�I�O• LUCYC INu. pARCELTAXI.D.� PERMI # <br />f�lo2 SC Lvc�ziiil�nll �Uui `���cc rk(r�}5 Cvzrc� bV�1 �ISi�.�� ��'� �oa -oc�� <br />LEGAL LOT NO. LO K TR CT OR SUBDIVISIOIJ p <br />SPaAI?f:0, InG. ��(�i P�rcarlholicvJ i;'d <br />TENAN?NAWE <br />Si�A�°f:0 <br />. , �l1cl��llc <br />CONTACTI <br />�li�,Ccr-, I���e. <br />Ny �i���l�� <br />)R ERMIT <br />- �t�I1C�1C1[e (aiUA�(t � <br />����7�J' ��0� <br />PHONE 7J�tJ-/�33_�>� y, II� <br />CONTRACTOfl �+uunw� -•� ��-�� <br />�fi��Crr,lr,C,. �3� Tu�Y,zs Sl.,�.n�lr�t;v, �yr��_�i���, Ny 1�,2b� <br />CONTR. LICENSE #.`�� L' * L J <br />Y A�co�7',io5lr I <br />USE OF BUILDING <br />7�r��r11 - 4��t1 ����rf F�eS�ai�r�tt�t <br />,�l5�"3h-��CO ;�iil <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />J F.IeGric __ Gas _ Olher � �-�� (,�� . <br />WORK DESCRIPTION ' � <br />�1lcdiarl�u�� (�IVA�) l.ut,�.i�,� ia�t l,rd<<i�,r b�.��lcic��t c� ��'�t.f�C� <br />�N� L�rer�,1l� ;1�1�t,ll «���1���� c�i��i�����f�ru�i�i ;��:�t�� . <br />_ .. :,.r_.,::,.-,� c.,���r,i��,o, �r��.�,t,ir -It 6o'11a-b���— <br />NO. I TYPE OF FI%TURE OR ITEfri <br />Toilet <br />Bathtub <br />Lava�ory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbar/mopletc.) <br />Backllo�v prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Rool drains <br />Other <br />r+o. <br />/ <br />� <br />/ <br />V <br />TYPE OF FI7TURE OR ITER7 <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALLS TAX CO�E IS 3105 <br />(y�Y���Gn � r.�r(d f i nC <br />I hereby ceri�ify that I have read and examined �his application and know Ihe same to be Irue and correct. All provisions of laws and <br />ordinaces goveming this lype o( work will be complied wi�h whether specitied herein or noL The granting of a permit does nol presume <br />to give authority to vioiate or cancei the provision ol any other state or local law regula�ing consiruction or the performance of <br />conslruction. That I am aulhorized by Ihe owner ol Ihis properry to pedorm �he work (or which appiication is made and I comply wiih Ihe <br />Stale Contrac�ors La�v 1827 RCW and 296.200 WAC. <br />, ll�-in('r;� � � crau�t7�� Il���e(ul(< l�) '�(cv� ro��1rJ�Dr: l C• �� D;, <br />SignaWr ot OwnerlCon�ractorlAuihonzed Agent / ��� �� <br />Z <br />� d,r� <br />